Complications of Distal Radius Fractures in the Elderly: A systematic review and meta-analysis

Abstract

Purpose:   Optimal treatment for elderly patients with distal radius fractures has remained controversial as the benefits and risks of surgical fixation are less clear than for a younger patient. Since complication rates can be unstable in small studies, synthesis may provide more accurate risk estimates.  The purpose of this review was to assess the complications associated with the treatment of distal radius fractures in elderly patients through a systematic review and meta-analysis of the literature.

Methods:  A PubMed, Medline, and Cochrane database search was conducted to identify articles for review. A broad search strategy using the keywords “complications” or “adverse events” and “distal/radius/wrist/colles/smith fractures” and “elderly” was used for data extraction.  Only English language articles published between January 1996 and December 2016 (within the past 20 years) were considered for review.

Results:  Based on our inclusion/exclusion criteria 20 studies were included for analysis. Sackett level of evidence (LOE) studies included were: 3 level one, 6 level two, 2 level three and 9 level four studies. There were 6 randomized control trials, 3 prospective cohorts, 2 case controls and 9 retrospective case series studies identified. The incidence of complications (i.e. requiring intervention) was significantly higher in the operative group (129/1095, 11.8%) versus the non-operative group (40/483, 8.3%) (p=0.008). External fixation (51/227, 22.5%) had significantly higher complication rates when compared to other fixation methods except dorsal plating (3/15, 20%). Percutaneous pinning (1/83, 1.2%) had significantly lower major complications compared to volar locked plating (VLP) (14/86, 16.3%). Furthermore, percutaneous pinning (0/83, 0%) had significantly less reoperation rates when compared to the VLP group (11/86, 12.8%) (p=0.006).

Conclusion:  Given that complication rates are less with percutaneous pinning than plating, this minimally invasive fixation may have advantages for fixation of fractures in older adults.